Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru.

OBJECTIVES: Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. METHODS: The study was implemented from September 2009-November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. RESULTS: Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the "two for one strategy", offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. CONCLUSIONS: Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing

Elimination of Congenital Syphilis in Ukraine: Analysis and the Emerging Issues

The objective of this study is to analyze the indicators of the process of elimination of mother-to-child transmission of syphilis in Ukraine thus helping to prepare for elimination of this process according to the WHO targets and criteria.Epidemiological and clinical data of 237 women who had syphilis before or during pregnancy and babies born to them (238) from 1999 to 2007 years were presented. In addition were used statistical forms of the Public Health Center and Center for Medical Statistics of the Ministry of Health of Ukraine for the incidence of syphilis and HIV in women of reproductive age, pregnant women and children born to them, including those who were diagnosed with congenital syphilis (CS) and HIV infection.Analysis of the causes of СS suggests that the main risk factors in Ukraine were the lack of prenatal care in 44 % and treatment in 99 % of pregnant women with syphilis. Besides out-of-date normative base regulating STI diagnostic and care create delay in diagnostics and treatment of pregnant women and their newborns.In addition, the delay with prenatal diagnosis and treatment, late infection, quality of diagnostics, iatrogenic errors, refusal of women from current requirement for hospitalization, reinfection, and birth at home can be attributed to risk factors for CS.Despite the main target indicator of CS elimination has been achieved, process indicators of syphilis as coverage of syphilis testing and treatment of pregnant women as well as other additional requirements have not reached yet.On the way to the CS elimination Ukraine is facing a few challenges. There is an urgent need on further year the new strategy on STI/СS prevention with targets and targets indicators. In addition national protocols of the treatment of pregnant women should be adapted according to the European Guidelines as well as comprehensive data is required for surveillance and monitoring of CS elimination

TESTING PATTERNS FOR SYPHILIS AND OTHER SEXUALLY TRANSMITTED INFECTIONS IN PREGNANT WOMEN PRESENTING TO EMERGENCY DEPARTMENTS

Following an initial decrease in the incidence of congenital syphilis from 2008-2012, the rate of congenital syphilis rose by 38% across the United States between 2012-2014 (2). This trend followed a 22% rise in primary and secondary syphilis cases in women during the same period.(1) Vertical transmission of syphilis is a significant public health concern, contributing to stillbirth, infant mortality, and neurologic and skeletal morbidities in survivors. (2) The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for sexually transmitted infections (STI) including HIV, syphilis, and hepatitis B at the first prenatal visit regardless of prior testing. The American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) also support similar recommendations. Yet, a CDC investigation into this epidemic revealed that 21% of women whose infants were diagnosed with congenital syphilis had no prenatal care, and of those who had at least one prenatal visit, 43% received no treatment for syphilis during pregnancy and 30% received inadequate treatment. (2, 3) Little is understood about factors associated with low STI screening during pregnancy in the US. In a 2014 study, Cha, et al. evaluated factors affecting the likelihood of STI screening in pregnant women in Guam. They found that the biggest barrier to STI testing was lack of prenatal care and insurance. Even women with access to prenatal care were not routinely screened for syphilis before 24 weeks’ gestation. Despite a 93.5% overall rate of screening for syphilis at any time during pregnancy, the authors found much lower screening 2 rates for other STIs, including 31% for HIV, 25.3% for chlamydia, and 25.7% for gonorrhea. (8) This suggests potential disparity in testing practices based on risk perception by providers or patients

Five year retrospective study on Syphilis in the Sexual Transmitted Disease (STD) centre of the teaching hospital Umberto I in Rome

Objectives: A retrospective study describing syphilis epidemiological and clinical features in patients referring to an infectious diseases centre in Rome, Italy. Methods: Between January 2011 and December 2015 demographic, behavioral and clinical data were collected from all adult patients attending the Sexual Transmitted Disease Centre of the Teaching Hospital Umberto I in Rome. Results: Overall 723 patients, 495 males and 228 females, with syphilis infection diagnosis were included. Average age 39.6 ± 13.6 years (median 38) was higher in men than women (41.1 ± 13.6 vs. 36.3 ± 13.1; p<0.001). Patients were from Italy (486 or 67.2%), EU (90 or 12.4%), rest of Europe (38 or 5.3 %), Americas (46 or 6.4%), Africa (36 or 5.0%) and Asia (27 or 3.7%). One-hundred-twenty-three (17.0%) presented primary syphilis, 43 (5.9%) secondary syphilis, 8 (1.1%) tertiary syphilis, 246 (34.0%) serological syphilis, 80 (11.1%) preceding syphilis, 56 (7.7%) gravidic syphilis and 167 (23.1%) came to the STD to control a preceding syphilis treatment. Fifty-six (24.6%) women were diagnosed with syphilis during their pregnancies. Among Chinese female patients, those pregnant represented 87.5%. There were 100 subjects (13.8%) simultaneously HIV+ and 623 (86.2%) HIV- patients. HIV co-infection affected more frequently men (RR 5.30; CI 2.62 – 10.72; p<0.001). In males HIV co-infection affected more frequently homosexuals (RR 11.72; CI 6.72 – 20.45; p<0.001). Overall HIV co-infection affected more frequently foreign patients, specially from the Americas (26.1%), Africa (25.7%) and Asia (22.2%). Conclusions: A serious problem of “gravidic syphilis” suggests the need for Public Health preventive action. Also an early diagnosis of both syphilis and HIV infection should be reinforced

Syphilis screening in pregnancy in the United Kingdom, 2010-2011: a national surveillance study

OBJECTIVE: To evaluate the national antenatal syphilis screening programme and provide evidence for improving screening and management strategies. DESIGN: National population-based surveillance. SETTING: United Kingdom (UK). POPULATION: All pregnant women screening positive for syphilis, 2010-2011. METHODS: Demographic, laboratory and treatment details for each pregnancy were collected from UK antenatal units (~210), along with follow-up information on all infants born to women requiring syphilis treatment in pregnancy. MAIN OUTCOME MEASURES: Proportion of women with newly or previously diagnosed syphilis among those with positive screening tests in pregnancy; proportion requiring treatment. RESULTS: Overall, 77% (1425/1840) of reported pregnancies were confirmed syphilis screen-positive. Of these, 71% (1010/1425) were in women with previously diagnosed syphilis (155 requiring treatment), 26% (374/1425) with newly diagnosed syphilis (all requiring treatment) and 3% (41/1425) required treatment but the reason for treatment was unclear. Thus 40% (570/1425) required treatment overall; of these, 96% (516/537) were treated (missing data: 33/570), although for 18% (83/456), this was not until the third trimester (missing data: 60/537). Follow up of infants born to treated women was poor, with at least a third not followed. Six infants were diagnosed with congenital syphilis; two mothers were untreated, three had delayed treatment and one had incomplete treatment (first trimester). CONCLUSION: Over 2 years, among pregnant women with confirmed positive syphilis screening results in the UK, a quarter had newly diagnosed infections and 40% required treatment. Despite high uptake of treatment, antenatal syphilis management could be improved by earlier detection, earlier treatment, and stronger links between healthcare teams. TWEETABLE ABSTRACT: 25% of pregnant women screening positive for syphilis in the UK were newly diagnosed and 40% needed treatment

Ineffective penicillin treatment and absence of partner treatment may drive the congenital syphilis epidemic in Brazil

BACKGROUND: Reducing congenital syphilis has been the focus of Brazilian health programs for decades, yet the cases continue to increase. Although health interventions have targeted HIV screening and treatment, syphilis management continues to be challenging. Syphilis during pregnancy may enhance the HIV maternal seroconversion risk. The potential factors fueling the syphilis epidemic were evaluated in south Brazil, an area of high HIV or syphilis endemicity. OBJECTIVE: We hypothesized that ineffective treatment because of a lack of partner treatment, late presentation to care, and reinfection of previously treated mothers were potential drivers of syphilis mother-to-child transmission. STUDY DESIGN: Data on women diagnosed with syphilis during pregnancy between January 1, 2008 and December 31, 2018 were obtained from a large urban hospital in Porto Alegre, Brazil. The patients were stratified into effective vs ineffective treatment groups according to the World Health Organization guidelines. Crude and adjusted risk ratios for the prediction of congenital syphilis and adverse fetal or neonatal outcomes were computed using Poisson regression. RESULTS: Nearly 56,000 pregnant women delivered over the 11-year period; 1541 (2.8%) had confirmed syphilis during pregnancy, with 934 (61%) receiving ineffective syphilis treatment because of late presentation and diagnosis, delayed treatment initiation, and loss to follow-up with no treatment recorded. Ineffective treatment was associated with maternal education, prenatal care, timing of syphilis diagnosis, venereal diseases research laboratory titers, and maternal HIV coinfection. On multivariate regression analysis, ineffective treatment (adjusted risk ratio, 4.52; 95% confidence interval, 2.35–8.69), absence of prenatal care (adjusted risk ratio, 9.31; 95% confidence interval, 3.77–23.0), syphilis diagnosis at delivery (adjusted risk ratio, 3.08; 95% confidence interval, 2.07–4.58), and maternal nontreponemal titers ≥1:64 (1.09–1.93) were associated with an increased risk of fetal loss. Ineffective treatment (adjusted risk ratio, 1.71; 95% confidence interval, 1.59–1.84), year of diagnosis 2014 to 2016 (adjusted risk ratio, 1.07; 95% confidence interval, 1.02–1.13), absence of prenatal care (adjusted risk ratio, 1.44; 95% confidence interval, 1.17–1.76), and maternal nontreponemal titers >1:4 were associated with an increased risk of congenital syphilis. Although partner treatment reduced the congenital syphilis risk (adjusted risk ratio, 0.60; 95% confidence interval, 0.55–0.66), only 31.8% of partners received treatment. Maternal HIV coinfection was not associated with an increased risk of fetal loss, low birthweight, preterm birth, congenital syphilis, or symptomatic neonatal infection. CONCLUSION: Public health initiatives promoting effective syphilis treatment in pregnancy, increased access to high-quality prenatal care, and partner treatment should be considered to reduce congenital syphilis.Revisión por pare

Syphilis serology in HIV-positive and HIV-negative Nigerians: The public health significance

Syphilis has acquired new potential for morbidity and mortality through association with increased risk for HIV infection. Case-control survey was conducted using Rapid Plasma Reagin test and confirmatory Immunochromatographic test among HIV-positive (cases) and HIV-negative (control) Nigerians. A total of 35(14.0%) of 250 HIV-positive and 5(2.0%) of 250 HIV-negative individuals studied were seropositive for syphilis, the difference was statistically significant (P<0.05). The prevalence was higher among females than males of HIV-positive (15.0% versus 12.7%) and of the HIV-negative (2.1% versus 1.9%) individuals. Syphilis seroprevalence was highest among HIV-positive individuals aged 21-30 years (20.5%) and 41-50 years old HIV-negative individuals (4.5%). Sex education, promotion of safer sexual behaviour, prompt diagnosis of STDs and provision of effective, accessible treatment are recommende

Syphilis - a disease that still occurs

Introduction: Syphilis is a systemic disease caused by Treponema pallidum. Humans are the only hosts, and the incubation period lasts from 9-90 days. Currently it can be divided into congenital or acquired. This division is due to the moment in which the infection occurred. Congenital Syphilis- when the infection happens during the prenatal period, whereas acquired, when the infection took place in the period after birth. In early acquired syphilis the I and II stages can be distinguished as well as early latent syphilis. As defined, early latent syphilis includes an acquired infection up to 1 or 2 years back, depending on the guidelines. Late syphilis however includes: late latent syphilis, tertiary syphilis, late cardiovascular syphilis, late neurosyphilis. Congenital syphilis has also been divided into early (which includes the first 2 years) as well as late, which is characterised by signs of congenital syphilis, the so-called stigmata of congenital syphilis constituting the untreated infection during the fetal stage or the infancy stage.  Aim of the Study: The aim of our study is to divert the attention to one of the sexually transmitted diseases, which despite the downward trend at the end of the 20th century, rebounded at the beginning of the 21st century, especially among men who have sexual contact with other men. We paid attention to the symptoms accompanying this disease, also in the context of congenital syphilis, as well as the different methods of pharmacological treatment according to European guidelines.  Materials and methods: Reviewed literature available at scientific articles , Google Scholar using keywords: “syphilis – epidemiology”, “syphilis treatment”, “symptoms of syphilis”, as well as European guidelines regarding the treatment of syphilis

Syphilis screening in the antenatal care: a cross-sectional study from Botswana

BACKGROUND: Congenital syphilis is recognized as a substantial public health problem in Sub-Saharan Africa. The aim of this study was to determine the prevalence of syphilis among antenatal care attendees in Botswana and to contribute to knowledge about the challenges facing the syphilis-screening programme. METHODS: In a cross-sectional study, 703 antenatal care attendees at 13 health facilities in Gaborone, Botswana were interviewed and examined. Venous blood samples were collected for the identification of syphilis infection. The antenatal records were used to obtain information on any screening, diagnosis and treatment of syphilis that had been done earlier in the current pregnancy. RESULTS: Active syphilis was found in 32 (5%) of the attendees. Among 546 women coming for a repeat antenatal care visit, 71 (13%) had not been screened for syphilis. Uptake late in pregnancy, delayed treatment and a high rate of seroconversion after testing were other identified obstacles to the effective prevention of congenital syphilis. CONCLUSION: Syphilis prevalence among pregnant women in Botswana remains high, and there is still much to be gained by improving the effectiveness of the syphilis screening and treatment programme. Earlier antenatal care attendance, rapid on-site testing, improved partner treatment and a repeat test late in pregnancy to manage incident cases are important goals for patients, health care workers and health authorities

Mathematical Modelling of Syphilis Transmission Dynamics: Impacts of Mass Media Report, Risky Sexual Behavior and Treatment

Abstract Syphilis is one of the deadly sexually-transmitted diseases. This paper studied the impacts of sexual behavior, mass media report and treatment of infected individuals on the dynamics of syphilis transmission. The analytical and numerical analyses of the model are presented. The disease free equilibrium of the model is both locally and globally asymptotic stable when the associated reproduction number is less than unity.&nbsp; Analysis of the Reproduction number shows that it is not possible to control syphilis disease transmission if the rate of individuals practicing risky sexual behavior is high. Furthermore, the treatment of late (latent and tertiary) syphilis infection is beneficial to the infected individuals, but has no impact in the lowering of the reproduction number. This study suggests that the effective control strategy of syphilis must focus on lowering the number of individuals practicing risky sexual behavior and applying higher treatment rates for early syphilis infections. Furthermore, the media function should address the issues regarding safe sexual behavior. Keywords: Syphilis, sexually transmitted infection, Risky sexual behavior, Mass medi